16 November 2017, Manchester

TAngible TOys (TATO) with sensors and

biofeedback mechanism: Explorative

work to assess its suitability and

feasibility as a tool for treating anxious

children

1 June 2017-30 April 2018

Maki Rooksby, William Simm, Laura Sbaffi, Massimiliano Zecca & Eiman Kanjo

Stories via

tangible toys

• Go anywhere with the child

• Children talk about their fears

• Continuity of care outside consultation time

• Up to 12 years of age

• Sensors on toys

✤Vision

✤ Child anxiety

disorder

High prevalence

Poor prognosis

High cost to

society

Poor access to

help

High attrition

Comorbidity

Biofeedback patch on

child

• Helps gain insight into cause/nature of anxiety?

• Acceptable?

Sensing systems

Quality of play via

sensor embedded toys

Biofeedback on the

child

Smarter Intervention

Identify index mental

states (worries, fears)

Suitability x condition

severity

EPS challenges

Human-Centric systems & Living

Better

Personalised toys

Long term management

Sustained interest

Can grow with the child

🐰 : H i i t ’ s T AT O t i m e !

Friendly pop-up avatar

delivers activities (e.g., via

mobile phone)

Sense of trust

Therapeutic alliance

Data analytics

Appropriate and ethical

data management and

sharing

Cognitive

capacities: High

Severity of

anxiety: High

Severity of

anxiety: Low

Cognitive

capacities: Low

8-year old

Geoff has

ASD.

Academically

talented but he

can get very

anxious at

school socially

10-year old

Simon has

ADHD and LD.

Disruptive and

compulsive

behaviour are

his main issues

7-year old Siena

can get very

anxious in a new

place, so her

family knows to

prepare her well

before they go out.

9-year old Tess has

OCD. She can’t

stand certain

auditory and tactile

stimuli. She suffers

from meltdowns and

repetitive behaviour.

Thoughts on

TATO persona

✤ TATO-compatible clinical

profile

✤ Not for everyone

✤ Specific instructions for

shaping narratives

✤ Role of biofeedback may be

critical

✤ “Talk to me about the time

when you felt…”

Personas, User Stories and Use Cases

✤ The personas will help the team to share understanding, communicate and understand the needs of our users.

✤ From personas we will develop User Stories and be able to abstract use cases (cf. agile software development)

✤ We will reason about and identify the critical target audience for the TATO devices using these use cases

✤ These use cases will allow us to prioritise development objectives, and select participants

✤ Personas will be continuously developed as we engage with the workshop(s) and evolve our domain understanding

1. NHS ethics

• 12 weeks

• Ongoing [Delay: 2 months +]

• Change of clinician, changes to study design

• NHS reviewers change twice, now need re-writing application

2. Literature review

• 24 weeks (to Dec 2017)

• Scoping review on available technology/those in development/design process addressing child anxiety

• 2nd rater coding of >1500 papers

• Delay: 1 month for the search

3. Technological materials

• Throughout

• Sampling suitable devices for children

• Make selections and place orders after fund transfer

4 & 6. Recruitment and Participatory design workshops

• October 2017 onwards

• Liaise with clinicians to arrange consent

• 1st workshop about now [delayed]

• Document workshops and steering group meetings

5. Team meetings and communication

• Throughout

• Kick off meeting in September

• Schedule difficulty

• Skype meetings

• A couple of Skype discussion between MR and different members of the team

7. Steering group meetings with clinicians and families

• Week 21 onwards (about now)

• Caring experience for anxious children

• Clinical challenges of treating anxious children

• How TATO could facilitate benefits such as treatment ease/alliance

8. Larger grant proposal

• February onwards

• Prepare for May 2018 for stage 2 funding

9. Dissemination

• February onwards

• Aim at a conference workshop/late emerging work paper in technological domain

• A scoping review paper in WP2

0 2 4 6 8 10 12 14

Dissemination

Stage 2 proposal

Participatory Desgin workshops

Clinician&Family Steering groups

Recruitment

Ethics application

Scoping review

Tech materials

Team communication

TATO Timescale

month start Month end delay

✤ Scoping review

✤ Contexts for child anxiety:

✤ Neurodevelopmental conditions : ASD/autism, ADHD

✤ Other medical conditions- migraine, asthma, epilepsy

✤ Types of studies found so far:

✤ Games teaching coping/social skills paired with biofeedback capacity

✤ Participatory/design process studies

✤ Use of virtual reality

✤ Humanoid robots combining tactile, speech functions

Narrative therapy embedded with technology seems to be a minority

✤Progress

✤ Reasonable progress with scoping review

✤ Delay with fund transfer and ethics review

✤ 2 personnel changes with NHS R&D, change in

review opinions

✤ Change of clinician, change in study arrangements

✤ Positive changes are also brought to the study

Priority for speedy ethics process completion

Contingency plan to make the most of the remaining time

✤Additional activities

1. Scoping review

✤ Small group of experts in mental health technology

assess and comment:

2. Participatory design workshops with non-NHS

children from general public

✤ Contingency for ongoing delays with NHS REC

✤ Likely to be valuable given the high prevalence and

the continuous nature of the condition

• University and NHS

• Nov. Re-write NHS; Submit University ethics

• Dec. R&D approval

• Biofeedback

• Workshop protocol

• Consent

• Children with complex needs

• CAMHS outpatients

• Community sample

• Clinicians and

• families

• Paper selection

• Analysis

• Expert consultation

• Write up

Scoping review

Submit: March 2018

Design workshops

NHS:March Non-NHS:

Jan., March

Ethics approval

NHS: Feb 18

University: Dec.17

Liaison with Clinical team

Feb 2018

✤ Iterative Workshop Structure:

1. Observe free play

2. Telling stories through play

3. Augment toys with sensors

4. Add Biofeedback sensors

✤ We plan to be agile and are prepared to mix methods:

✤ Some children will not deal well with groups so may need private sessions

✤ Some children may not like to wear some sensors

https://www.bluemaestro.com

http://www.shimmersensing.com/

✤ Outcomes of feasibility workshop:

✤ Development of target use cases for project focus

✤ Initial feedback from users

✤ Initial data collected from devices

✤ These will inform future work in terms of:

✤ Workshop design

✤ Sensor design and choice

✤ Data will inform data science infrastructure requirements

✤ Stage 2 TATO

✤ Further explore TATO user profiles

✤ Benefits and risks by social, clinical and economical variables

✤ Family as part of user profile

✤ Sharing of the technology, data, privacy & trust

✤ Further iterative process with a larger team and wider user groups:

✤ Clinicians of different traditions, practice artists, family members across lifespan with caring experience of child anxiety

Thank you.

Questions?